Working Healthy

Diagnosing Diabetes

Diabetes isn’t just on the rise in this country: It’s skyrocketing. Not only are more people getting diabetes, but they’re developing it younger than ever. With an estimated six million people undiagnosed, doctors recommend all at-risk people take the simple and fast test.

Frances Watson, owner of Fancy Feet Foot Salon in Alford, Fla., knew she was at risk for diabetes because her father had had it and she was overweight with high blood pressure. Still, it didn’t click with her when, she started seeing floating spots in front of her eyes, or even when she found herself thirsty all of the time. Next came some kidney problems, but it wasn’t until she was hospitalized for chest pains last year that her doctor diagnosed her with diabetes.

“I was always expecting it, but when they told me I didn’t believe it,” she remembers. Stunned, Watson at first took the prescribed medications and modified her diet, but before long, she went into denial and began skipping her medication and reverting to her old, unhealthy eating habits. Before long her condition worsened and she even began to consider closing her in-home salon. Fortunately, she instead faced up to the disease and met with a nutritionist, modified her diet, and began an exercise program. Now, she’s feeling so good that she’s reconsidering her decision to close her foot care salon. “I have to eat a certain mix of foods at certain times,” she explains. “I’ve lost 25 pounds, and now I’m exercising, which is very important for a diabetic. If I lose 50 more pounds then I think I’ll be just great and I might be able to get off the medications.”

Watson is by no means alone in her struggle against diabetes: The incidence of diabetes has increased eight-fold in the past 15 years alone, says Marian Parrott, M.D., a spokesperson for the American Diabetes Association (ADA). The ADA estimates that more than 16 million Americans have diabetes, though approximately six million of them don’t yet know it because they aren’t been screened and have yet to complain of any of the secondary diseases (such as eye or kidney disease) that often signal diabetes.

Diabetes is the seventh-leading cause of death in the United States, and while it’s not a “woman’s” disease per se, it’s estimated that 8.2% of all women in this country have it. And until people take steps to reduce their risk factors for diabetes, those numbers are not only exerted to continue growing, but to strike at increasingly early ages.

“We’re finding a shift of type 2 diabetes to earlier and earlier ages, to the point where we now have almost an epidemic in kids younger than age 14, which a population where type 2 was rarely found before,” says Daniel L. Gallina, I.D., a professor at Emory University school of Medicine and medical director of Emory Diabetes Center in Atlanta.

What Is Diabetes?

According to Dr. Parrott, the most amnion myth about diabetes is that it stems from eating too much sugar. In reality, explains the National Institute of diabetes and Digestive and Kidney Diseases (NIDDK), diabetes is a disorder of he way our bodies use digested food —in particular sugars, fats, and carbohydrates—for growth and energy. The digestive juices break down most of the food we eat into a simple sugar called glucose, which is the main source of fuel or the body. After digestion, the glucose asses into the bloodstream, where it’s available for body cells to use. However, for the glucose to get into the cells, insulin — a hormone produced by the pancreas — must be present. According to the NIDDK, when we eat, the pancreas is supposed to automatically produce the right amount of insulin to move the glucose from our blood into our cells. In people with diabetes, however, the pancreas produces either little or no insulin, or the body cells for some reason do not respond to the insulin that is produced. Either way, says NIDDK, glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus the body loses its main source of fuel even though the blood contains large amounts of glucose.

There are three main types of diabetes: type 1, type 2, and gestational diabetes (discussed later). Type 1 diabetes is an autoimmune disease in which the body’s immune system for some reason attacks and destroys the insulin-producing cells of the pancreas. Type 1 diabetes accounts for only 5%-10% of all cases of diabetes and most often strikes children and young adults.

Type 2 diabetes, on the other hand, accounts for 90% or more of the cases of diabetes. In these people, their pancreas either doesn’t make enough insulin or it doesn’t use what it makes properly.

The warning signs of type 1 diabetes include frequent urination, unusual thirst, extreme hunger, unusual weight loss, extreme fatigue, and irritability. People with type 2 diabetes can experience any of those symptoms as well as frequent infections, blurred vision, cuts/bruises that are slow to heal, tingling/numbness of the hands or feet, and recurring skin, gum, or bladder in­fections. However, people with type 2 diabetes often have no symptoms and are diagnosed because of other complications. The two types also differ in that type 1 symptoms usually develop over a short period, while type 2 symptoms develop more gradually.

Who’s at Risk?

With type 1 diabetes, researchers are making progress in identifying the genetic markers that will reveal those more prone to developing the autoimmune disorder, but they’re not quite there. According to the Centers for Disease Control and Prevention, researchers suspect that type 1 diabetes appears following exposure to “an ‘environmental trigger’,such as an unidentified virus, stimulating an immune attack against the beta cells of the pancreas in some genetically predisposed people.”

Researchers haven’t had much more luck identifying the genetic markers that show a predisposition to type 2 diabetes. However, Dr. Gallina says they have identified a number of factors that point to high-risk populations. They include:

Obesity (considered 20% more than your ideal weight)

A family history of diabetes

High blood pressure (140/90 or higher)

Having delivered a baby weighing 9 pounds or more or having had gestational diabetes

Members of high-risk ethnic groups such as African Americans, Latinos, Native Americans, and Asian Americans

“We think many of the world’s people have ‘thirty’ genes — genes that keep them from starving to death in times of famine,” says Dr. Parrott of the high-risk ethnic groups. “These genes affect our appetite, our ability to lose weight, and our likelihood to gain it” Add our access in America to rich, sweet foods and other kinds of junk food, and the combination of a diet high in fatty foods and the resultant weight gain set the stage for diabetes. Too, Dr. Parrott says researchers believe that genetics play a strong role in the development of type 2 diabetes, but they haven’t yet pinpointed those genes.

Diabetes in Women: The Complications

In and of itself, the high blood sugar level in diabetics is problematic because it leads to thirst, dehydration, fatigue, and an overall weakness. Untreated diabetics are almost always hungry because glucose is unavailable as fuel Weight loss can be another problem as the body loses water and fat and protein tissues as it attempts to compensate for the lack of fuel.

As problematic as these symptoms are, they can be a blessing in disguise in that they’ll often spur the person to seek medical help. However, as noted earlier, people with type 2 diabetes often experience no symptoms, or their complaints are so vague they don’t think to ask for a diabetes test, nor does their doctor think to order one. Undiagnosed and uncontrolled diabetes also is associated with long-term complications that affect almost every major body system. For example, diabetes contributes to blindness, heart disease, strokes, kidney failure, amputations, and nerve damage.

According to the American Diabetes Association, women are particularly at risk for peripheral vascular disease and coronary heart disease, stroke, or cardiac failure.

Diabetic coma is brought on by poorly controlled diabetes and is marked by high blood glucose levels, caused by a lack of insulin, and ketones (by products of fat metabolism in the blood).

Peripheral vascular disease, on the other hand, results in reduced flow of blood and oxygen to tissues in the feet and legs. The principal symptom of the disease is intermittent pain in the thigh, calf, or buttocks during exercise. Peripheral vascular disease can lead to many problems with the legs and feet and, without great care, can lead to amputation.

Finally, women with diabetes should know that birth control pills can affect their blood glucose levels, while IUDs may lead to increased infections.

Baby and Me...and Diabetes Makes Three?

According to the ADA, pregnancy demands more insulin in the body than normal because the body increases its production of hormones that can lead to insulin resistance. For women with diabetes, says the ADA, excellent blood glucose control before conception and throughout the pregnancy is vital to prevent an increased risk of birth defects and newborn death.

In addition to women with diabetes who get pregnant, an additional 2%-5% of pregnant women will develop what’s called gestational diabetes, a form of diabetes that occurs only during pregnancy. Women who develop gestational diabetes are much more likely than those who don’t to develop type 2 diabetes later in life; and almost half of those who are obese before pregnancy and develop gestational diabetes will develop type 2 diabetes within just four years. All pregnant women should be checked for gestational diabetes between the 24th and 28th weeks of pregnancy unless they are younger than 25, have no family history of diabetes, have a normal body weight, and are not members of a high-risk ethnic group.

Treatment and Prevention

Researchers continue to seek a cure to diabetes, exploring everything from pancreas transplants to genetic manipulation of fat or muscle cells, but at this point, Drs. Gallina and Parrott say that our best bets lie in preventive measures. According to the CDC, a number of studies show that regular physical activity can significantly reduce the risk of developing type 2 diabetes. Additionally, Dr. Parrott recommends individuals maintain their ideal weight and eat “nutrient-dense” foods to get all the nutrients we need without exceeding our recommended caloric intakes.

Because early intervention can minimize complications or delay their onset, Dr. Gallina recommends that people who fall into the high-risk categories also should request a test for diabetes. Too, every individual should be routinely screened for diabetes at age 45, and every three years thereafter if the first test is within normal range.

For those already diagnosed, recent studies such as the Diabetes Control and Complications Trial, found that participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of eye, kidney, and nerve compli­cations. “Intensive management” includes constant monitoring of blood sugar levels and aggressive use of dietary, exercise, and medication controls.

In retrospect, Watson wishes she had taken control of her diabetes earlier, as she says she feels better now than she has in years. “Before, I just existed. Now, I feel like doing something all the time,” she says.